Bone fixation system

ABSTRACT

A bone fixation system is provided. The bone fixation system may include a plate, one or more fasteners configured to attach the plate to a target anatomical location such as bone, and a surgical device that facilitates the attachment of the plate and the fasteners.

CROSS REFERENCE TO RELATED APPLICATIONS

This application is a divisional of U.S. patent application Ser. No.14/694,075, filed Apr. 23, 2015, which is a divisional of U.S. patentapplication Ser. No. 13/078,188, filed Apr. 1, 2011, which claims thebenefit of U.S. Provisional Patent Application Ser. No. 61/417,614 filedNov. 29, 2010, and further claims the benefit of U.S. Provisional PatentApplication Ser. No. 61/320,883 filed Apr. 5, 2010, the disclosures ofall of which are hereby incorporated by reference as if set forth intheir entirety herein.

BACKGROUND

Fractured bones are a common injury seen in trauma centers. Surgeons intrauma centers frequently encounter many different types of fractureswith a variety of different bones. For stabilizing a bone fracture, ametal fixation plate with suitable holes is fixed to bone fragments onopposing sides of the fracture using metal screws or pins. Typically thescrews are self-cutting and are rotated into threadless openings in thebone, or they are screwed into pre-drilled threaded openings. Fracturefixation using such plates and screws may include several proceduralsteps and several instruments. For example, a first instrument may beused to cut the holes in the bone, and then a second instrument may beused to place the screws or pins. Therefore, the complexity and durationof the surgery may be unnecessarily lengthy and complex.

SUMMARY

Disclosed is a surgical fastener may include a body that includes afirst portion and a second portion. The body may define a bore thatextends through at least the first portion along a longitudinal axis ofthe body. The bore may be configured to receive a cutting mechanism. Thefirst portion of the body may be transmissive to electromagneticradiation and the second portion of the body may be absorptive toelectromagnetic radiation such that upon absorbing electromagneticradiation the second portion of the body softens and is capable ofdeforming. In one embodiment, the body defines a proximal end and adistal end spaced from the proximal end along the longitudinal axis, theproximal end is configured to attach to a surgical device that emits anenergy source, and the first portion is disposed proximally with respectto the second portion. In another embodiment, the first portion may bean inner core portion and the second portion may be an outer peripheralportion.

The surgical fastener may be part of a kit that includes both a boneplate and at least one polymer based fastener. The bone plate may becomprised of a thermoplastic material. The fastener may include a bodythat defines a first portion, and a second portion. The second portionmay have laser absorbing properties. The fastener may also include abore that extends through at least the first portion of the body. Thebore may be configured to receive a cutting mechanism.

Also disclosed is a surgical device configured to implant a surgicalfastener into a target anatomical location. The surgical device mayinclude a hand piece having a body that is configured to support afastener that has a body and a bore that extends through the body. Thesurgical device may also include a cutting mechanism and an energysource. The cutting mechanism may be configured to extend through thebore of the fastener and cut into a target anatomical location. Theenergy source may be configured to heat and soften a portion of thefastener.

Also disclosed is a method of fixation of a surgical fastener to atarget anatomical location. According to the method a hole may be cutinto the target anatomical location by using a cutting mechanism of asurgical device. A fastener that is attached to a tip of the surgicaldevice may be advanced into the hole of the boney structure as thecutting mechanism is cutting the hole. An energy source of the surgicaldevice may then be activated to thereby heat the fastener so as tosoften at least a portion of the fastener. Once finished the surgicaldevice may be removed while the fastener remains attached to the boneystructure.

BRIEF DESCRIPTION OF THE DRAWINGS

The foregoing summary, as well as the following detailed description ofpreferred embodiments of the application, will be better understood whenread in conjunction with the appended drawings. For the purposes ofillustrating the surgical fasteners and devices of the presentapplication, there is shown in the drawings preferred embodiments. Itshould be understood, however, that the application is not limited tothe precise arrangements and instrumentalities shown. In the drawings:

FIG. 1 is a schematic view showing a surgical device fixating a boneplate to bone with a surgical fastener;

FIG. 2A is a longitudinal cross-sectional view of a surgical fasteneraccording to one embodiment, the surgical fastener having a core portionand a peripheral portion capable of deforming;

FIG. 2B is a transverse cross-sectional view of the surgical fastenershown in FIG. 2A, the core portion and the peripheral portion are joinedsuch that the surgical fastener is configured as a one-piece fastener;

FIG. 2C is a transverse cross-sectional view of the surgical fastenershown in FIG. 2A, the peripheral portion being a coating disposed on thecore portion;

FIG. 3A is a front elevational view of a surgical fastener in accordancewith another embodiment, the surgical fastener having a distal portioncapable of deforming;

FIG. 3B is a longitudinal cross-sectional view of the surgical fastenershown in FIG. 3A;

FIG. 3C is a transverse cross-sectional view of the surgical fastenershown in FIG. 3A, including an optical waveguide extending through thebore of the fastener;

FIG. 3D is a front elevational view of a surgical fastener in accordancewith another embodiment, the surgical fastener including closedirrigation channels;

FIG. 4A is a side elevational elevation view of a surgical deviceconfigured to affix a bone plate to bone using a surgical fastener;

FIG. 4B is a schematic view showing a first laser, a second laser and anirrigation supply of the device shown in FIG. 4A;

FIG. 4C is a detailed side view illustrating the tip of the device shownin FIG. 4A holding a surgical fastener for affixing a bone plate tobone;

FIG. 4D is a detailed side view illustrating the tip of the device shownin FIG. 4A holding another embodiment of the surgical fastener foraffixing a bone plate to bone;

FIG. 5A is a schematic view of a surgical device being positioned toaffix a bone plate to bone;

FIG. 5B is a schematic view of the surgical device shown in FIG. 5Aactivating a first laser to drill through the bone plate and bone, andsimultaneously advancing a surgical fastener;

FIG. 5C is a schematic view of the surgical device shown in FIG. 5Bactivating a second laser to soften at least a portion of the surgicalfastener; and

FIG. 5D is a schematic view showing the surgical fastener affixing thebone plate to bone after the surgical device is removed.

DETAILED DESCRIPTION

Referring to FIG. 1, a bone fixation system 10 includes a plate 14, oneor more fasteners 18 configured to attach the plate 14 to a targetanatomical location such as bone 26, and a surgical device 22 thatfacilitates the attachment of the plate 14 and the fasteners 18. Itshould be appreciated that the bone 26 can include two or more fracturedbone segments, such as bone segments 26A and 26B, or can include anyother deformity amenable to treatment using bone fixation. Moreover, thetarget anatomical location may be structure other than bone, such asligaments, and other soft or hard tissue structures. As shown, the plate14 is placed over or onto the bone 26, and the surgical device 22 may bepositioned over the plate 14 to cut a hole in either the plate 14, thebone 26, or both, so as to affix the plate 14 to the bone 26 using thefastener 18. The fixation of the plate 14 using one or more fasteners 18and the surgical device 22 may be performed using a single device. Forinstance, only a single device 22 can be used to cut a hole, place thefastener 18, and affix the plate 14 to the bone 26 with the one or morefasteners 18. It should be understood that the entire fixation system 10may be sold as a kit or alternatively, the plate 14, and the one or morefasteners 18 may be sold as a kit themselves. For instance, a pluralityof fasteners 18 having different sizes and/or shapes can be provided asa kit.

Alternatively or additionally, a plurality of plates 14 having differentsizes and/or shapes can be provided as a kit. Alternatively oradditionally still, a combination of fasteners 18 and plates 14 havingthe same or different sizes and/or shapes can be provided as a kit,either alone or in combination with the surgical device 22. Furthermore,while the fasteners 18 are illustrated as pins, they can alternativelybe provided as screws having threaded surfaces, nails having smooth ortoothed surfaces, bolts, or any alternative fixation device configuredto fix the bone plate 14 to the underlying bone 26.

As shown in FIG. 1, the surgical device 22 includes a hand piece 82, anda control unit 86 that is connected to the hand piece 82 by a cord 90.The control unit supplies a cutting mechanism 46 that is configured tocut the holes into the plate 14 and the bone 26, and an energy source 70that is configured to heat and soften the fasteners 18 to thereby attachthe plate 14 to the bone 26. The cutting mechanism 46 may include afirst laser 94 and an irrigation system 98, and the energy source 70 mayinclude a second laser 102. The first laser 94, the irrigation system 98and the second laser 102 are arranged in the control unit 86 anddelivered to the hand piece 82 of the surgical device 22 through thecord 90.

The plate 14 provides a load bearing structure that can be connected tobone fragments. The plate 14 is preferably made from a polymer material.For example the plate 14 may be made from poly-alpha-hydroxyester,polyorthoester, polyanhydride, polyphosphazenes,poly(propylenefumarate), polyesteramide, polyethylenefumarate,polylactide, polyglycolide, polycaprolacton, trimethylenecarbonate,polydioxanone, polyhydrobutyrate, as well as their copolymers andmixtures. The plate 14 may also include electromagnetic radiationabsorption properties. For example, the plate 14 may include anadditive, such as chlorophyll, carbon black, iron oxide, graphite,fluorescein, methylene blue, indocyanine green, eosine; eosine Y (514nm), ethyleosine (532 nm), acridine, acridine orange, copperphtalocyanine, chrome-cobalt-aluminum oxide, ferrous ammonium citrate,pyrogallol, logwood extract, chlorophyll-copper complex, D&C blue No. 9,D&C green No. 5, [phtalocyaninate(2-)] copper, D&C blue no. 2, D&C blueno. 6, D&C green no. 6, D&C violet no. 2, and D&C yellow No. 10, whichallows the plate 14 to absorb energy such as heat from the second laser102. In operation, the portion of the plate 14 that has theelectromagnetic radiation absorption properties, absorbs the laser beamand deforms, thereby contributing to the fixation of the plate 14 to thebone 26. In another embodiment, the electromagnetic radiation absorbingcomponent may include magnetic nano-particles, and the second laser 102may be replaced by an electromagnetic transmitter that emits anelectromagnetic signal in the range of 20 kHz to 10 GHz. Alternatively,ultrasonic vibrations, a conventionally heated metal bolt or heated airflow might be used for melting the fastener/plate.

Further, the plate 14 may be provided without predrilled holes and thusmay define a continuous surface between opposing edges along a lengththat defines a target location for the insertion of one or more of thefasteners 18. During installation, the cutting mechanism of the surgicaldevice 22 may be used to produce holes in the plate 14. It should beunderstood, however, that the plate 14 is not limited to plates definingcontinuous surfaces, and may be provided with pre-drilled holes.Furthermore, it should be understood by one of skill in the art, thatthe plate 14 and the holes may be provided in a variety of shapes andsizes.

As shown in FIGS. 2A-2C each surgical fastener 18 includes a body 44that is elongate in a longitudinal direction L and defines a distal endD and a proximal end P. Each surgical fastener 18 further includes abore 48 that extends through the body 44 in the longitudinal direction Land along a longitudinal axis 49 that may define a central axis of thefastener 18. In this way, the body 44 is tubular having an outerdiameter D1 that defines an external surface 55 of the body 44, and aninner diameter D2 that defines an internal surface 52 of the body 44. Asshown, the body 44 may be separated into a first or core portion 50adjoining the internal surface 52, and a second or peripheral portion 51adjoining the external surface 55.

The body 44 of the fastener 18 is made from a thermoplastic material,for example poly-alpha-hydroxyester, polyorthoester, polyanhydride,polyphosphazenes, poly(propylenefumarate), polyesteramide,polyethylenefumarate, polylactide, polyglycolide, polycaprolacton,trimethylenecarbonate, polydioxanone, polyhydrobutyrate, as well astheir copolymers and mixtures. The peripheral portion 51 of the body 44adjoining the external surface 55 is colored sufficiently to includeelectromagnetic radiation absorption properties while the core portion50 of the body 44 adjoining the internal surface 52 is transmissive tothe electromagnetic radiation provided by the energy source. Forexample, the colored peripheral portion 51 may include an additive, suchas chlorophyll, carbon black, iron oxide, graphite, fluorescein,methylene blue, indocyanine green, eosine; eosine Y (514 nm),ethyleosine (532 nm), acridine, acridine orange, copper phtalocyanine,chrome-cobalt-aluminum oxide, ferrous ammonium citrate, pyrogallol,logwood extract, chlorophyll-copper complex, D&C blue No. 9, D&C greenNo. 5, [phtalocyaninate(2-)] copper, D&C blue no. 2, D&C blue no. 6, D&Cgreen no. 6, D&C violet no. 2, and D&C yellow No. 10, which allowsabsorption of electromagnetic radiation provided by the second laser102.

By absorbing the energy of the second laser 102, the thermoplasticmaterial of the peripheral portion 51 heats up and softens. That is, thesoftening of the fastener 18 occurs by the heat generated by theabsorption of radiation from the second laser 102, to the point thatallows the fastener 18 to be deformed. In particular, the additive, andin some cases some of the thermoplastic itself absorbs the laser andheats up to thereby cause the thermoplastic to soften. The softenedthermoplastic material is capable of deforming and expanding into thehollow spaces of the bone tissue thereby affixing the fastener 18 andthe plate 14 to the bone 26. The peripheral portion 51 may absorb atleast twice as much irradiated energy as the core portion 50. Typically,however, a factor of 5-1000 times more energy is absorbed in theperipheral portion 51 with respect to the core portion 50. In otherwords, the peripheral portion 51 may absorb 50-100% of the energy, whilethe core portion 50 absorbs 0-10%. The thickness of the peripheralportion 51 is preferably over 0.1 mm and/or between 1 to 20% of theouter diameter D1. It should be understood that the peripheral portion51 is not limited to thermoplastic materials capable of absorbing thesecond laser 102 and that other materials may be used. For example, theperipheral portion 51 may include magnetic nano-particles, and the lasercan be replaced by an electromagnetic transmitter that emits anelectromagnetic signal in the range of 1 kHz to 1 MHz or 100 KHz to 100GHz.

The core portion 50 of the fastener 18 which is transmissive to theelectromagnetic radiation may be configured so as not to warm-up at allor only partially, and to maintain its mechanical strength. At the sametime, the core portion 50 can serve as an optical element and transmitthe energy onward into the bone plate 14. The fastener 18 can then bepushed into a previously produced hole which may be undersized, and thewarmed-up, softened polymer is then pressed into the interspaces of thebone. After turning off the energy source, the polymer (thermoplasticmaterial) cools off and quickly hardens (<1-2 minutes), and themechanical interdigitation between the fastener 18 and the bone and/orthe bone plate 14 is established.

The core portion 50 and the peripheral portion 51 may be separatediscrete components that are coupled together with the peripheralportion 51 e.g. being a coating that includes the electromagneticradiation absorbing properties as shown in FIG. 2C, or they may beintegral and thus one component, with the peripheral portion 51comprising a chromophore (i.e. color or pigment) as shown in FIG. 2B.Further, in some embodiments, the peripheral portion 51 may be a zonewith a variable absorption coefficient “a”. In any case, the peripheralportion 51 includes the electromagnetic radiation absorbing propertiessufficient to cause the peripheral portion 51 to deform in response toexposure to the first laser 94, while the region of thermoplasticmaterial of the core portion 50 has a transparency to the second laser102 that is greater than that of the peripheral portion 51. Therefore,the inner uncolored core portion 50 substantially maintains itsstructural integrity when exposed to the first laser 94 that deforms theperipheral portion 51.

As shown in FIGS. 3A-3D, in another embodiment, a fastener 18A includesa body 44A having first and second portions that are aligned withrespect to a direction that extends substantially parallel to thelongitudinal axis 49. As shown in FIG. 3B, the body 44A of the fastener18A may include a first axial portion 64 and a second axial portion 60disposed distally with respect to the first portion 64. The firstportion 64 may be transmissive to electromagnetic radiation, while thesecond portion 60 may be configured to absorb electromagnetic radiation.

As with the fastener 18, fastener 18A may be made from a thermoplasticmaterial. For example each fastener 18A may be made frompoly-alpha-hydroxyester, polyorthoester, polyanhydride,polyphosphazenes, poly(propylenefumarate), polyesteramide,polyethylenefumarate, polylactide, polyglycolide, polycaprolacton,trimethylenecarbonate, polydioxanone, polyhydrobutyrate, as well astheir copolymers and mixtures. The second axial portion 60 can becolored throughout its complete volume, and includes electromagneticradiation absorption properties that allow the second portion to absorbenergy provided by for example the laser 102, and the first axialportion 64 is transmissive to the energy provided by the laser 102. Forexample, the colored second portion 60 may include an additive, such aschlorophyll, carbon black, iron oxide, graphite, fluorescein, methyleneblue, indocyanine green, eosine; eosine Y (514 nm), ethyleosine (532nm), acridine, acridine orange, copper phtalocyanine,chrome-cobalt-aluminum oxide, ferrous ammonium citrate, pyrogallol,logwood extract, chlorophyll-copper complex, D&C blue No. 9, D&C greenNo. 5, [phtalocyaninate(2-)] copper, D&C blue no. 2, D&C blue no. 6, D&Cgreen no. 6, D&C violet no. 2, and D&C yellow No. 10, which allowsabsorption of electromagnetic radiation provided by the second laser102. In operation, the thermoplastic material in the complete volume ofthe second axial portion 60 of the fastener 18A absorbs the laser beamand deforms, thereby affixing the plate 14 to the bone 26. In anotherembodiment the second axial portion 60 may include magneticnano-particles, and the first laser may be replaced by anelectromagnetic transmitter that emits an electromagnetic signal in therange of 20 kHz to 10 GHz.

The first axial portion 64 and the second axial portion 60 may beseparate discrete components that are coupled together, or they may beintegral and thus one component, with the second axial portion 60 havinga coating that includes the electromagnetic radiation absorbingproperties. In either case, the second axial portion 60 includes theelectromagnetic radiation absorbing properties sufficient to cause thesecond axial portion 60 to deform in response to exposure to an energysource such as the laser beam 102, while the thermoplastic material ofthe first axial portion 64 has a transparency to the laser beam 102 thatis greater than that of the second axial portion 60, such that theuncolored first axial portion 64 substantially maintains its structuralintegrity when exposed to the laser beam 102 that deforms the secondaxial portion 60. The second axial portion 60 is shown in FIG. 3B asbeing disposed at the distal end “D” of the body 44, and the first axialportion 64 is illustrated as being disposed proximal with respect to thesecond axial portion 60. The colored second axial portion 60 may be from10 to 80% of the overall length of the fastener 18A along thelongitudinal direction.

As shown in FIGS. 3A-3D, the fasteners may be provided with irrigationchannels 59 configured as recesses 56 or closed passages 57 asillustrated in FIGS. 3A and 3D. As shown in FIGS. 3A and 3B, a fastener18A includes a hollow-cylindrical body 44A that is elongate along alongitudinal axis 49. The body 44A includes an external surface 55A thatdefines an outer diameter D1. As shown, each fastener 18A includes abore 48A that extends through the body 44A in the direction of thelongitudinal axis 49. As shown, the bore 48A has an inner diameter D2that defines an internal surface 52A of the body 44A. The body 44Afurther defines a plurality of irrigation channels 59 configured asrecesses 56 that extend into the internal surface 52A along the entirelength of the bore 48A from the proximal end P to the distal end D.While the body 44A is illustrated as defining three circumferentiallyequidistantly spaced recesses 56 (i.e. disposed at 120° when viewed incross-section), the body 44A can include any number of recesses 56 asdesired spaced circumferentially about the body 44A as desired. As shownin FIG. 3A, in cross-section, each recess 56 may be in the shape of ahalf circle and may be configured to receive and carry an irrigationfluid. Each recess 56 may have a radius of about 0.1 mm to about 0.5.The recesses 56 may be radially spaced apart from each other to providea number of irrigations channels 59 that allow an irrigation fluid to beinjected through e.g. two of the three irrigation channels 59 and to besucked off through e.g. one of the three irrigation channels 59. Itshould be understood, however, that the recesses 56 are not limited tobeing half circles and may be any shape capable of receiving anirrigation liquid.

In another embodiment and as illustrated in FIG. 3D the fasteners mayinclude irrigation channels 59 that are closed passages 57. As shown, afastener 18B includes a tubular body 44B, a bore 48B that extendsthrough the body 44B, and three circumferentially equidistantly spacedclosed passages 57 that extend through the body 44B between an internalsurface 52B and an external surface 55B of the body 44B, such that nocommunication to the bore 48B exists. While the body 44B is illustratedas defining three circumferentially equidistantly spaced passages 57,the body 44B can include any number of passages 57 as desired spacedcircumferentially about the body 44B as desired.

The fasteners 18, 18A, and 18B may be provided in a variety of sizes.For example, the outer diameter D1 of each fastener may be between 1.5and 5 mm and the bores of the fasteners may have a diameter D2 of about0.4 mm to 3 mm. Furthermore, the fasteners may have a length T extendingalong the longitudinal axis 49 that is between about 3 mm and about 20mm long. The dimensions provided are for illustrative purposes only, andit should be understood that the fasteners may include any dimensioncapable of affixing the plate 14 to the underlying bone 26.

The color material or particles may be worked into the polymer of thefasteners using a variety of methods. For example, color-containingpolymer layers or implant elements can be produced in a so-calledtwo-component injection molding process. In this case, the uncoloredportion of the fastener is injected in a first phase, and aftermodifying the cavity in the injection mold, the color containing portionis injected in a second phase.

The layers of color-containing polymer may also be achieved by applyingand drying the color and polymer containing solutions. It is in thiscase possible to achieve layers of color containing polymer bydepositing and drying the color and polymer containing solutions,similar to a candle-drawing process (dip-coating process) or byspraying. The use of the first-mentioned depositing process allowsachieving layers of a very thin (micrometer-thin) up to a very thick(sub- and millimeter range) size.

The color layer(s) may also be achieved by applying and dryingcolor-particles containing suspension or solution. In this case, thecoating occurs by first warming-up the color-containing particles. Theheated particles may then be jetted onto the surface of the uncoloredpart of the fastener, so that the particles fuse with the polymer of theuncolored portion of the fastener and are fixated on the surface.

Ceramic or other non-thermally sensitive particles may also be appliedto the surface by jetting them onto the polymer surface in a heatedcondition, where they can locally fuse with the polymer and be fixatedin the surface. An example for this is given by the plasma sprayingprocess by which hip joint prostheses are for instance coated withcalcium phosphate particles. The use of processes such as Chemical VaporDeposition (CVD) or Physical Vapor Deposition (PVD) is also conceivablein the presence of suitable substrates.

Each fastener may be positioned and affixed to the plate 14 and the bone26 using the surgical device 22 shown in FIGS. 4A-4C. As shown, thesurgical device 22 includes a hand piece 82, a control unit 86, and acord 90 connecting the hand piece 82 to the control unit 86. Thesurgical device 22 is a processing apparatus configured to provide boththe cutting mechanism 46 and the energy source 70. In the embodimentshown, the cutting mechanism includes a first laser 94 and an irrigationsupply 98 that is connected to a first optical waveguide 95, while theenergy source 70 includes a second laser 102 that is connected to asecond optical waveguide 103. The first laser 94 and irrigation supply98 may be configured to cut through the plate 14, the bone 26, or both,and the second laser 102 may be configured to heat and deform the secondaxial portion 60 or the tubular peripheral portion 51 of the fasteners18, 18A, and/or 18B. The irrigation supply 98 is configured to supply acoolant liquid and to remove the debris from the cutting site. Theoptical waveguides 95, 103 may be flexible or rigid opticallight-transmitting structures, such as for instance glass fiber cablesor reflecting hoses (e.g. also nano-tubes) used to transmitelectromagnetic radiation from the source to the fastener. On the otherhand, the fastener itself may serve as an optical fiber and lightdiffuser. After entering the fastener, the light is transmitted throughthe first portion of the fastener until it arrives at the point wherethe softening of the polymer, mostly at its surface, is to take place.In order to transmit the light through the optical fiber to the fastenerup to the desired point, the fastener may on one hand actually transmitthe light, meaning for instance to the tip of a pin and then distributeit there, so as to reach the surface of the fastener, for instance bydiffusion.

In one embodiment, the first laser 94 is a 3 μm infrared laser, theirrigation supply 98 uses a liquid such as water, and the second laser102 is an 800 nm infrared laser. It should be understood, however, thatthe device 22 is not limited to a cutting mechanism 46 comprising the 3μm infrared laser, and water supply, nor is it limited to an energysource 70 comprising the 800 nm infrared laser. For example, the cuttingmechanism 46 may also be a 10 μm CO₂ laser combined with an irrigationsupply, or a 2.8 μm Erbium YAG laser combined with an irrigation supply.Similarly, the second laser 102 may be a laser having a wave length inthe range of 400 nm to 1800 nm or it may be replaced by anelectromagnetic transmitter in the range of 20 kHz to 10 GHz, or bothinfrared lasers may be replaced by an ultrasonic source capable of both:(i) cutting through the plate 14, and the boney structure 26, and (ii)heating and thereby softening the fastener 18.

The control unit 86 includes each of the first laser 94, the irrigationsupply 98, and the second laser 102. The control unit 86 can includesettings that are controlled by a user to determine the operation of thebone fixation system. For example, a user may at first set the controlunit 86 to simultaneously supply the first laser 94, and the irrigationsupply 98, to cut through the plate 14 and the bone 26, and thenmid-procedure, change the control unit 86 to supply the second laser 102to deform the fastener 18.

As shown in FIGS. 1, and 4A-4C, the hand piece 82 includes an elongatedbody 110 having a tip 114 at its distal end and a connecting portion 118at its proximal end for connecting the body 110 to the cord 90. Theelongated body 110 is generally a tube-like structure that isconstructed to contain said first and second waveguides 95, 103 and/orirrigation tubes 126 a, 126 b, as shown in FIG. 4C. The first and secondoptical waveguides 95, 103 may be optical fibers, which are configuredto transmit the beams of the first and second laser 94 and 102 from thecontrol unit 86 through the body 110 and to the tip 114. Similarly, theirrigation tubes 126 are configured to transport the irrigation liquidfrom the control unit 86 through the body 110 and to the tip 114 and tosuck the irrigation fluid off in the reverse direction, and can thusalso be referred to as irrigation tubes. A fiber tip end 130 proximateto the distal end of the fastener disperses the beam of the first laser94 as desired so as to allow the hole that is cut into the plate 14 andbone 26 to have a diameter that allows the fastener to pass through. Thefiber tip end 130 can give way several mm back into the device 22, toenable compression of the second axial portion 60 of the fastener insidethe boney structure 26. For example, as the fastener is compressed downby a user, the fiber tip end 130 may be retracted proximally either bytranslating proximally with respect to the handle, or by compressing, asa portion of such as the axial portion 60 of the fastener 18A compressesor otherwise deforms.

Referring also to FIG. 3C, the first optical waveguide 95 is configuredto extend through the bore 48 of the body 44 of the fastener 18. Inparticular, the first optical waveguide 95 defines a diameter that issubstantially equal to the diameter of the bore 48. Thus, the bore 48 ofthe fastener 18 is sized to receive the first optical waveguide 95 thatguides the beam of the first laser 94 such that there is littleclearance between the first optical waveguide 95 and the internalsurface 52 of the bore 48. As a result, the first optical waveguide 95substantially closes the inner radial ends of each of the recesses 56 soas to define a plurality of irrigation channels 59, which extend alongthe length of the fastener 18.

FIG. 4C illustrates a tip 114 configured to be used with a fastener suchas fastener 18, as shown in FIG. 2A, and fasteners 18A, and 18Bincluding irrigation channels 59 as shown in FIGS. 3A and 3D. The tip114 is configured to grip and hold or otherwise support the fasteners.The proximal end P of the fastener 18 can comprise an attachment portion45 that can be e.g. configured as a cylindrical portion dimensioned fora press fit with a corresponding bore 140 in the tip 114. As shown, thetip 114 includes a channel 144 extending from a wall 146 and toward thedistal end of the tip 114, and a bore 140 that extends proximally fromthe distal end of the tip 114 in alignment with the channel 144. Thebore 140 defines a diameter greater than that of the channel 144, suchthat the tip 114 provides a seat 148 at the interface between the bore140 and the channel 144. The interface abuts and supports the fastener18 at the distal end of the channel 144 when the fastener 18 is fullyinserted or otherwise disposed in the bore 140. The channel 144 isseparated into an injection segment 145 a for injecting an irrigationliquid and a suction segment 145 b allowing to suck off the irrigationliquid together with the debris. The hand piece body 110 furtherincludes a first and a second port 150, 151 extending into the tip 114.Each of the first and second ports 150, 151 has a coupling 154 at itsproximal end for coupling an irrigation tube 126 a, 126 b thereto and anopening 158 at its distal end. The openings 158 of the first and secondport 150, 151 extend into the channel 144 so as to place the channel 144in fluid communication with the couplings 154 of the first and secondport 150, 151.

The bore 140 is sized to receive and hold a fastener such as fasteners18A or 18B as described above, and the channel 144 is configured toguide the irrigation liquid of the irrigation supply 98 from the portopening 158 to two irrigation channels 59 of the fastener which can berecesses 56 or closed passages 57 and to suck the irrigation fluid andthe debris off through the third irrigation channel 59 of the fastener18.

A first irrigation tube 126 a is connected to the coupling 154 of thefirst port 150, and the irrigation liquid of the irrigation supply 98travels through the first irrigation tube 126 a, into the injectionsegment 145 a of the channel 144 via the first port 150 and through twoirrigation channels 59 of the fastener. A second irrigation tube 126 bis connected to the coupling 154 of the second port 151, and theirrigation fluid with the debris can be sucked off through the thirdirrigation channel 59 of the fastener 18 defined by the third irrigationchannel 59 into the suction segment 145 b of the channel 144 and via thesecond port 151 into the second irrigation tube 126 b.

The beam of the first laser 94 and the irrigation liquid of theirrigation supply 98 may simultaneously travel longitudinally throughthe fastener 18A and out the distal end D of the fastener 18A to therebycut the hole into the plate 14 and/or the bone 26. As shown, the beam ofthe second laser 102 may be guided to a front or proximal wall 160 ofthe fastener 18A. When the second laser 102 is activated, the lighttravels through the transparent first axial portion 64 of the fastener18A, and is absorbed by the laser absorbing second axial portion 60.Alternatively, when using a fastener 18 according to FIGS. 2A to 2C thelight travels through the thermoplastic material in the core portion 50and is absorbed by the laser absorbing colored thermoplastic material ofthe peripheral portion 51 adjoining the external surface 55 of thefastener 18, and by the adjacent portion of the plate 14.

The tip 114 may be a sterile single use part that may consists of afastener, such as anyone of fasteners 18, 18A, or 18B and the fiber tipend 130 that is configured to adequately cut through the bone 26 (notethat the fiber tip end may be shaped in a way to disperse the laserbeam, so that it is actually possible to drill a hole that is largeenough to fit the fastener—which is larger than the fiber tip. Thesingle use part may be configured to be selectively attached to ordetached from a distal end of the body 110. The single use part may alsobe made from a material that is capable of being placed in an autoclave.

FIG. 4D illustrates another embodiment of the tip 114 configured to beused with a fastener 18 as illustrated in FIGS. 2A to 2C. The embodimentof the tip 114 according to FIG. 4D differs from the embodiment of FIG.4C only therein that the tip 114 comprises a sleeve 156 affixed to thetip 114 and comprising two or more bore holes 157 in fluid communicationwith the channel 144. The sleeve 156 can be inserted into the bore 48 ofthe fastener 18 and surrounds the first optical waveguide 95. The two ormore bore holes 157 are arranged circumferentially equally spaced andsuitable to guide the irrigation liquid of the irrigation supply 98 fromthe channel 144 to the tip 130. The channel 144 is separated into aninjection segment 145 a for injecting the irrigation liquid and asuction segment 145 b allowing to suck off the irrigation liquidtogether with the debris. The injection segment 145 a is configured toguide the irrigation liquid of the irrigation supply 98 from the portopening 158 through two or more bore holes 157 in the sleeve 156 that isinserted in the bore 48 of the fastener 18 and the suction segment 145 bis configured to suck the irrigation fluid and the debris off throughone or more of the bore holes 157 in the sleeve 156.

In operation and in reference to FIGS. 5A-5D the surgical device 22 mayaffix the plate 14 and the fastener 18 (or 18A or 18B) in a simple andefficient manner. As shown in FIG. 5A, the fastener 18 is placed intothe tip 114 of the hand piece 82 such that the fastener 18 partiallyextends distally of the tip 114, and the plate 14 is positioned on thebone 26 over the fractured area. The hand piece 82 along with thefastener 18 may then be positioned on the surface of the plate 14 and atan angle of 90° with respect to the plate 14, or offset with respect tothe 90° angle if desired. Once the hand piece 82 is positioned, thecontrol unit 86 may be activated to cause the beam of the first laser 94and the irrigation supply 98 to cut or drill a hole 55 through the plate14 and into the bone 26 if desired. As shown in FIG. 5B, the first laser94 and the irrigation liquid of the irrigation supply 98 travel throughthe bore 48 of the fastener 18 and out a distal end of the fastener 18.As the hole 55 is being cut, the hand piece 82 and thus the fastener 18may be gently pushed into the hole as it is created over time.

Once the desired depth of the hole is reached and the fastener 18 isproperly positioned within the hole, the control unit 86 may be switchedto deactivate the first laser 94 and the irrigation supply 98, andactivate the second laser 102 to thereby deform a portion of thefastener 18. As shown in FIG. 5C, the beam of the second laser 102 maysoften and deform the fastener 18 and the interface between the plate 14and the fastener 18. A gentle push of the device 22 in the direction ofsaid longitudinal axis 49 into the hole 55 causes a portion of thefastener 18 to deform and define an outer dimension that is greater thanthat of the hole 55. Thus, the fastener 18 transforms into a rivet 170that couples the plate 14 to the bone 26.

The bone fixation procedure described above can be performed to fix thebone plate 14 to one or more bone segments of the bone 26 that areseparated by a fracture. For instance, the bone plate 14 is positionedover the fracture site or fracture sites, and one or more fasteners cancouple the plate 14 to each bone segment in the manner described above.

As shown in FIG. 5D, the device 22 may be removed, while the plate 14and fastener 18 remain behind. The plate 14 and fastener 18 may be madefrom a resorbable material.

The foregoing description is provided for the purpose of explanation andis not to be construed as limiting the invention. While variousembodiments have been described with reference to preferred embodimentsor preferred methods, it is understood that the words which have beenused herein are words of description and illustration, rather than wordsof limitation. Furthermore, although the embodiments have been describedherein with reference to particular structure, methods, and embodiments,the invention is not intended to be limited to the particulars disclosedherein. Moreover, any of the embodiments described above can incorporateany structures or features of any of the other embodiments describedabove, as desired. Those skilled in the relevant art, having the benefitof the teachings of this specification, may effect numerousmodifications to the invention as described herein, and changes may bemade without departing from the spirit and scope of the invention asdefined by the appended claims.

What is claimed is:
 1. A method of fixing a surgical fastener to atarget anatomical location, the method comprising steps of: directing alaser of a cutting mechanism of a surgical device toward the targetanatomical location so as to cut a hole in the target anatomicallocation; advancing the surgical fastener into the hole of the targetanatomical location as the surgical fastener is supported by thesurgical device; activating an energy source of the surgical device tothereby heat and soften at least a portion of the surgical fastener soas to attach the surgical fastener to the target anatomical location;and removing the surgical device while the surgical fastener remainsattached to the target anatomical location.
 2. The method according toclaim 1, wherein: the cutting step includes: placing a polymer basedbone plate on the target anatomical location; cutting a hole through theplate and into the target anatomical location by using the cuttingmechanism of the surgical device; and the removing step comprisesremoving the surgical device while the surgical fastener and plateremain attached to the target anatomical location.
 3. The methodaccording to claim 1, further comprising: pressing the surgical fastenerinto the hole in the target anatomical location during heating andsoftening of the portion of the surgical fastener.
 4. The methodaccording to claim 1, comprising heating the surgical fastener to such adegree that the fastener becomes at least partially deformable.
 5. Themethod of claim 1, wherein the advancing step comprises advancing thesurgical fastener into the hole as the cutting mechanism cuts the hole.6. The method according to claim 1, wherein the activating stepcomprises transmitting electromagnetic radiation from the energy sourceto the surgical fastener.
 7. The method according to claim 6, whereinthe activating step comprises transmitting the electromagnetic radiationthrough a transmissive portion of the surgical fastener to the portionof the surgical fastener.
 8. The method of claim 7, wherein theactivating step comprises transmitting the electromagnetic radiationthrough a core that defines the transmissive portion to an externalsurface of the surgical fastener that defines the portion.
 9. The methodof claim 7, wherein the activating step comprises transmitting theelectromagnetic radiation through a proximal end of the surgicalfastener that defines the transmissive portion to a distal end of thesurgical fastener that defines the portion.
 10. The method of claim 1,comprising a step of inserting the cutting mechanism into a bore thatextends into a body of the surgical fastener such that the cuttingmechanism supports the surgical fastener.
 11. The method of claim 1,wherein the activating step comprises heating the surgical fastener witha laser of the energy source, the laser of the energy source beingdifferent from the laser of the cutting mechanism.
 12. The method ofclaim 11, wherein the directing step comprises directing one of a 3 μminfrared laser, a 10 μm CO₂ laser, and a 2.8 μm Erbium YAG laser towardthe target anatomical location.
 13. The method of claim 11, theactivating step comprises heating the surgical fastener with a 800 nmlaser.
 14. The method of claim 1, further comprising injecting anirrigation fluid into a recess in the surgical fastener as the cuttingmechanism cuts the hole so as to remove debris from the hole.
 15. Amethod of fixing a surgical fastener to a target anatomical location,the method comprising steps of: extending a cutting mechanism of asurgical device through a bore of the surgical fastener; cutting a holein the target anatomical location as the cutting mechanism extendsthrough the bore of the surgical fastener; advancing the surgicalfastener into the hole of the target anatomical location as the surgicalfastener is supported by the surgical device and as the cuttingmechanism is cutting the hole; activating an energy source of thesurgical device to thereby heat and soften at least a portion of thesurgical fastener so as to attach the surgical fastener to the targetanatomical location; and removing the surgical device while the surgicalfastener remains attached to the target anatomical location.
 16. Themethod according to claim 15, wherein: the cutting step includes:placing a polymer based bone plate on the target anatomical location;cutting a hole through the plate and into the target anatomical locationwith the cutting mechanism of the surgical device; and the removing stepcomprises removing the surgical device while the surgical fastener andplate remain attached to the target anatomical location.
 17. The methodof claim 15, wherein the extending step comprises extending a firstoptical waveguide through the bore.
 18. The method of claim 17, whereinthe cutting step comprises directing a laser of the cutting mechanism ofthe surgical device toward the target anatomical location so as to cutthe hole in the target anatomical location.
 19. The method of claim 15,wherein the activating step comprises heating the surgical fastener witha laser of the energy source.
 20. The method according to claim 15,wherein the activating step comprises transmitting electromagneticradiation through a transmissive portion of the surgical fastener to theportion of the surgical fastener.